UPDATE: Focus on practice

May 23, 2003

Drugs from Canada; an HMO pays; CME

 

UPDATE

Focus on Practice

By Joan R. Rose

Jump to:Choose article section...Canadian drug pipeline may dry up Texas forces an HMO to pay doctors what's owed Physicians launch a medical mission to Iraq Uncle Sam is getting into the CME business The high court deals a blow to HMOs Our Web Poll

Canadian drug pipeline may dry up

Although federal law prohibits the reimportation of prescription drugs, the FDA and US Customs rarely take action against individuals who purchase medications from Canada for their own use. But earlier this year, the FDA warned that health plans and other groups that "aid and abet" the importation of prescription drugs from Canada could be held criminally liable.

The agency also appears ready to move against storefront operations that act as middlemen for US patients who purchase drugs from Canada. In a letter to Oklahoma-based Rx Depot, the FDA advised the company that its practices violate federal law and warned that the agency was prepared to take legal action against the firm.

Texas forces an HMO to pay doctors what's owed

PacifiCare of Texas has entered into a binding agreement that will pave the way for doctors and other providers in Texas to recoup millions of dollars owed them when three of PacifiCare's "delegated networks" filed for bankruptcy.

The networks (composed of IPAs and nonprofit health care corporations) had contracted with PacifiCare to provide care to its members and to act as PacifiCare's intermediary in paying doctors and hospitals. However, when the networks went under, millions in payments had not made their way to providers. The state then sued the HMO, claiming that it had failed to monitor the networks as required by law and was thus ultimately responsible for paying the claims. PacifiCare's refusal was a violation of "both the spirit and the letter of the Texas HMO Act and the Deceptive Trade Practices Act," the state charged. Now Texas has put the lawsuit on hold for several months to give PacifiCare time to honor its agreement and resolve the outstanding claims.

Physicians launch a medical mission to Iraq

The Physicians Committee for Responsible Medicine is sending a relief convoy of medical supplies to a children's hospital in Baghdad. The convoy will carry sutures, scalpels, intravenous equipment, anesthesia, and other emergency items, as well as a 20-foot container of soymilk, which can feed up to 30,000 children. (Soymilk withstands high desert temperatures and requires no refrigeration.) The donation commemorates the life and work of pediatrician Benjamin Spock, a member of PCRM's advisory board until his death in 1998.

Uncle Sam is getting into the CME business

CMS plans to test a new CME program that will award AMA Physician's Recognition Award category 1 credits to physicians who participate in projects designed to improve the care provided in their offices or clinics. Doctors can earn up to 10 CME credits a year in each of three clinical areas—diabetes, influenza/pneumococcal immunizations, and breast cancer screening.

For information on how to obtain these credits, contact your local Quality Improvement Organization (QIO). You can find it by visiting the CMS Web site at cms.hhs.gov/contacts. (All Medicare QIOs, except those in Alabama, Puerto Rico, and the Virgin Islands, are participating.)

The high court deals a blow to HMOs

The US Supreme Court has unanimously upheld Kentucky's any willing provider (AWP) laws, which require health plans to accept into their networks any health care provider willing to abide by the plan's terms. HMOs had contended that the federal Employee Retirement Income Security Act (ERISA) pre-empts state laws relating to employee benefit plans. The high court, however, agreed with the appellate court that AWP laws are insurance regulations and thus excluded from the ERISA pre-emption.

Six other states—Georgia, Idaho, Illinois, Indiana, Minnesota, and Wyoming—have AWP laws that apply to physicians.

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Joan Rose. UPDATE: Focus on practice.

Medical Economics

May 23, 2003;80:13.